Speciality
Spotlight

       




 


Medicine


   

 




Postherpetic
Neuralgia

   

  • Naoki
    Kotani, Tetsuya Kushikata, et al

    Intrathecal methylprednisolone
    for intractable
    postherpetic
    neuralgia


    New
    Eng J Med. 343Nov.23, 2000, 1514-1519

      

    There
    is no effective treatment for postherpetic
    neuralgia. As
    there is evidence that there is an inflammatory
    component in this disorder, the authors have
    assessed treatment with intrathecally. administered
    methylprednisolone to reduce pain.

      

    Editorial

     

    A New Treatment for Postherpetic Neuralgia

      

    Randomized
    controlled trials have supported the use of older
    antidepressants – such as amitryptyline,
    nortryptiline, but nearly 50% patients either do not
    respond or have intolerable adverse effects.
    Recent trials of methylprednisolone + lidocaine
    have supported the use of the anticonvulsant -
    gabapentin, (fewer side effects), opioid oxycodone
    and a lidocaine skin patch.

     

    Currently,
    lidocaine skin patch may be used at the start, if no
    relief, use nortryptyline (fewer side effects) at a
    low dose of 10-20 mg/day, with gradual increase in
    dosage. Alternatively,
    gabapentin may be used starting with a low dose and
    upto a maximum of 3500mg/day.
    Opioids can be used in refractory cases.

      

    However,
    none of these approaches are fully satisfactory.
    In the study by Kotani et al during the 2 yrs
    of trial no critical adverse effects, such as
    arachnoiditis or neurotoxic effects from
    methylprednisolone were noted.
    However, use of this technique in larger
    number of patients and observation during longer
    follow up periods will be needed to identify
    potentially severe adverse effects. 
    This study does not address the problem of
    postherpetic neuralgia involving the trigeminal
    nerve.

          

 



 

           

Speciality Spotlight

       

 
Medicine
   

 

Postherpetic Neuralgia
   

  • Naoki Kotani, Tetsuya Kushikata, et al
    Intrathecal methylprednisolone for intractable postherpetic neuralgia
    New Eng J Med. 343Nov.23, 2000, 1514-1519
      
    There is no effective treatment for postherpetic neuralgia. As there is evidence that there is an inflammatory component in this disorder, the authors have assessed treatment with intrathecally. administered methylprednisolone to reduce pain.
      
    Editorial
     
    A New Treatment for Postherpetic Neuralgia
      
    Randomized controlled trials have supported the use of older antidepressants – such as amitryptyline, nortryptiline, but nearly 50% patients either do not respond or have intolerable adverse effects. Recent trials of methylprednisolone + lidocaine have supported the use of the anticonvulsant - gabapentin, (fewer side effects), opioid oxycodone and a lidocaine skin patch.
     
    Currently, lidocaine skin patch may be used at the start, if no relief, use nortryptyline (fewer side effects) at a low dose of 10-20 mg/day, with gradual increase in dosage. Alternatively, gabapentin may be used starting with a low dose and upto a maximum of 3500mg/day. Opioids can be used in refractory cases.
      
    However, none of these approaches are fully satisfactory. In the study by Kotani et al during the 2 yrs of trial no critical adverse effects, such as arachnoiditis or neurotoxic effects from methylprednisolone were noted. However, use of this technique in larger number of patients and observation during longer follow up periods will be needed to identify potentially severe adverse effects.  This study does not address the problem of postherpetic neuralgia involving the trigeminal nerve.
          

 

 

By |2022-07-20T16:42:03+00:00July 20, 2022|Uncategorized|Comments Off on Postherpetic Neuralgia

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